Investigate the therapeutic effects of bone marrow-derived mesenchymal stem cells transplantation on Asherman's syndrome

Investigate the therapeutic effects of bone marrow-derived mesenchymal stem cells transplantation on Asherman's syndrome
Yeganeh Gholami Someeh Bozorg ,¹ Mahtab Aghaee Jaghargh,^2,*
1. Midwifery student, School of Nursing, Midwifery and Medicine Islamic Azad University, Mashhad Branch, Mashhad, Iran
2. Midwifery student, School of Nursing, Midwifery and Medicine Islamic Azad University, Mashhad Branch, Mashhad, Iran
Introduction: Asherman's syndrome (AS) can occur following uterine curettage, Instrumentation, or infections in the pregnant or recently pregnant uterine cavity. AS is a rare condition, although it has been reported in 13% of infertile patients and 7% of women with secondary amenorrhea. Women with AS have amenorrhea or hypomenorrhea, cyclical pelvic pain, endometriosis, infertility, and recurrent spontaneous abortions. Some reports suggest that bone marrow stem cells (BMSCs) may serve as a source of stem cells for endometrial regeneration in AS. These cells are one type of adult stem cells with the characteristics of self-renewal, multipotential differentiation, autotransplantation without immune rejection. This review aims to determine the therapeutic effects of BMSCs on AS.
Methods: Articles from 2010 to 2020 were collected from PubMed, google scholar, medlib, irandoc, ISC, SID, and Cochrane databases. Totally 638 articles were found. 620 articles were excluded by reading the title. 6 articles were excluded after reading the title and 1 article was excluded after reading the full text. Finally, 11 articles were selected. All selected articles were in English.
Results: 4 studies show that BMDSCs promote endometrial regeneration and restore fertility in patients with AS. 2 of these articles were clinical trials. In one of these articles, the method was hormonal replacement therapy (HRT) and then BMDSC injected through the femoral artery and menstruation restarted after 6 months and 2 successful pregnancies were achieved. In another study, BMDSCs injected intrauterine tow times and after the second time, all 5 patients became pregnant. 5 articles performed on mice showed that treatment with BMDSCs improves fertility after uterine injury and plays a functional role in the regeneration of endometrium. The results of an article performed on mice aren't in agreement with the current articles and provide no evidence that BMSCs can transdifferentiate into the endometrial epithelium. 1article shows that CD133+ or prominin-1 which is a surface antigen that defines a broad population of somatic stem cells can be useful in the treatment of AS.
Conclusion: Stem cell therapy is a promising novel approach for resistant cases of AS. Bone marrow is a well-known store of mesenchymal stem cells. BMSCs can be injected in both local and systemic transplantation and result in endometrial regeneration by increasing epithelial thickness and vascular endothelial growth factor expression, and decreasing the percentage of collagen deposition. We suggest that intrauterine injection is better because the number of cells that inject into the vein is more than local injection. Injected cells into the vein travel a farther distance to reach the target area and these cells are more likely to die due to exposure to blood toxic factors.
Keywords: Bone marrow-derived stem cell, Mesenchymal stem cells, Asherman syndrome, Intrauterine adhesion